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To the Editor: Dr Yaffe and colleagues¹ report that both patient and caregiver factors can predict whether patients with dementia will require placement for long-term care. There are 2 important nonpatient and noncaregiver determinants that they fail to comment on, however; first, physicians' ability to diagnose dementia in early stages and second, ease of access to physicians. In my experience, both these factors also contribute to early long-term care placement for patients with dementia and may be amenable to interventions.

In my practice as a rural geriatric psychiatrist, I am often the first to diagnose dementia (usually in moderate to severe stages) in patients who have been treated by their primary care physician for several years. Many of these patients are admitted from their home to our unit because of severe psychotic symptoms of dementia, and some of them are discharged to a nursing home. I believe that if these . . . [Full Text of this Article]

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RELATED ARTICLE

Patient and Caregiver Characteristics and Nursing Home Placement in Patients With Dementia
Kristine Yaffe, Patrick Fox, Robert Newcomer, Laura Sands, Karla Lindquist, Kyle Dane, and Kenneth E. Covinsky
JAMA. 2002;287(16):2090-2097.
ABSTRACT | FULL TEXT